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Ravi Board/OITE Prep > Shoulder Elbow > Flashcards

Shoulder Elbow Flashcards

1
Q

Humeral Head offset

A

Axis is 7-9mm lateral and 2-4mm anterior to center of head

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2
Q

incidence of FT cuff tears in RhA

A

25-40%

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3
Q

what motion is lost the most in Shoulder oA

A

Ext Rot

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4
Q

max amoun of eccentric reaming in glenoid

A

5mm or 15 degrees

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5
Q

adv to superior approach to TSA

A

reflect anterior deltoid off acromium - down side is humeral access Is worse, but great A-P glenoid access

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6
Q

how much Pec can be released

A

up to 1cm of superior pec

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7
Q

humeral head cut in TSA

A

leave 2-3mm medial to cuff insertion; OR just anterior to bare spot –> restores native version

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8
Q

stages of rehab in Scapular dyskinesia

A

full scapular motion and coordinating with trunk/hips (tx proximal to distal); then strengthen the scapular muscles

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9
Q

Scapular Dyskinesis pathology

A

stress on anterior capsule and posterosuperior labrum - > leads to labrum or cuff tears

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10
Q

Shoulder primary OA vs Inflammatora OA

A

Inflamm OA has more central wear and medial joint line; may have to resort to hemi bc no glenoid stock

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11
Q

HIGHEST risk factor for non-healing RCT

A

age > 65

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12
Q

UCL Elbow Bundles

A

Ant bundle is isometric in full ROM; Post bundle is longer in Flexion - changes the most from Ext to Flexion;

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13
Q

Lateral elbow ligament

A

radial band is isometric; lateral Ulnar collateral is lax in extension

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14
Q

internal impingement

A

seen in throwers; infra and posterior parts of supra get beat up during late cocking - can also have posterior superior labrum tears

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15
Q

what position to avoid after SLAP repair

A

ER at 90 Abduction

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16
Q

laterjet is most effective at which postion

A

60 of abduction

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17
Q

when can you being sport specific rehab after SLAP

A

8-12 weeks post-op

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18
Q

which lateral elbow ligament is most important

A

lateral ULNAR Collateral - the anterior band of this prevents valgus instability

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19
Q

next step after painful hook test for biceps rupture

A

MRI to confirm partial vs complete

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20
Q

what is bufford complex

A

cordlike MGHL with ABSENT Ant labrum - not the same as sublabral foramen

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21
Q

elbow ligament origins on humerus medial vs lateral

A

medial ligaments origin on EPI-condyle; lateral ligaments on CONDYLE

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22
Q

course of median nerve

A

lies MEDIAL to brachial artery in arm until elbow; runs on TOP of brachialis

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23
Q

stryker notch vs west point views

A

SN is for Hill Sachs; WP is for anterior glenoid bone loss

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24
Q

best MRI view for fatty degen of cuff

A

T1 sagittal at base of coracoid

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25
Q

advantage of US for cuff tear and re-tear

A

it_s a dynamic study - can help distinguish b/w scar and cuff

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26
Q

threshold for converting partial tears to FT

A

if Articular > 6mm; if bursal > 3mm

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27
Q

incidence of HAGL

A

in unstable shouilders - 7-9%

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28
Q

ALPSA

A

anterior labrum,GHL and periosteum are stripped and retracted medially

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29
Q

long thoracic nerve roots

A

C5-6-7

30
Q

medial winging resolution

A

usually by 24 months they resolve

31
Q

AC joint capsule strength

A

superior capsule provides 50% of strength for AP translation; post capsule is about 25%

32
Q

percentage of RCR that do NOT heal

A

50% - does not appear to affect outcomes

33
Q

Degen vs Acute Scubscap tears

A

Acute subscap tears can involve more of tendon with retraction, where as DEGEN tears are superior fibers

34
Q

post-op SLAp at 12 weeks

A

full ROM and strength

35
Q

Secondary scapular winging

A

due to glenohumeral or acromial pathology -NOT from LT nerve injury - resolves after primary pathology is addressed

36
Q

Shoulder OA capsule response

A

anterior capsule gets tight, posterior capsue gets redudant - lose Ext Rot

37
Q

reccurence rates of shouler instability based on age

A

if < 20y 90%; if 20-40 then 60%; if > 40 then < 10%

38
Q

incidence of RCT w/ shoulder dislocation

A

if 40-60 then 30%; if > 60 then 80%

39
Q

associated fracture with dislocation

A

if > 50y a/w GT frx

40
Q

primary POSTERIOR stabilizers of shoulder

A

SGHL, post band of IGHL, and CH lig

41
Q

exam of post shoulder dislocation

A

prominent coracoid, limited Ex Rot, may have compensatory scapular winging

42
Q

m/c complication of surg for post shoulder instability

A

Recurrence (7 to 50%); other complication can be stifness and adhesive capsulitis

43
Q

2 classic lesions of MDI

A

big pouch inferior capsule; deficient rotator cuff

44
Q

cuff tendonitis/impingment in pt < 20 years - worry about.

A

Multidirectional instability

45
Q

preganglionic brachial plexus palsy

A

flail arm caused by ROOT avulsions

46
Q

os acromiale types

A

pre (in front); meso (middle), meta (base/In back)

47
Q

role of CA ligament

A

via CH ligament it prevents anterior and inferior GH translation

48
Q

lateral vs medial scapular winging

A

lateral - spinal accessory n (top of scapula is prominent); medial - long thoracic (inferior border is prominent)

49
Q

shoulder pain after ball release

A

tears of supra or infra due to eccentric loading during arm deceleration

50
Q

eden lange procedure is

A

using levator scap; rhomboids to compensate for non functional trapezius and to fix lateral scapular winging

51
Q

nerve roots of long thoracic nerve

A

C5-6-7

52
Q

contraindication to lat dorsi transfer

A

subscap deficiency - poor outcomes

53
Q

role of elbow flexors during decel

A

prevent elbow hyperextension

54
Q

Connolly and Neer-McLaughlin procedures

A

Infra and GT transfer into Hill Sachs (Connolly) and Subscap and LT transfer into Reverse Hill Scahcs (N-M)

55
Q

where does biceps attach in glenoid

A

70% is posterior labrum; 25% is middle labrum

56
Q

ant vs post band of elbow and stiffness

A

post band is more variable in length throughout arc of motion - release in elbow contractures

57
Q

diff b/w MGHL and SGHL in scope view

A

MGHL runs below the border of subscap - basically crosses over it

58
Q

type 2 AC injury

A

AC out, CC are partially injured - non-op injury

59
Q

m/c complication of 2 incision biceps

A

LABC nerve palsy

60
Q

scapular movement during throwing

A

retracts during late cocking; protracts duing accel (due to serratus via long thoracic nerve)

61
Q

bennet lesion in throwers

A

mineralization of the posterior inferior capsule from traction injury in throwers

62
Q

does post shoulder tightness or GIRD improve symptoms

A

fixing post shoulder tightness by 7 weeks improves symptoms - imrpoving GIRD does not

63
Q

static progressive elbow splinting used for

A

flexion contracture >30 deg or inability to get more than 130 deg

64
Q

how to do jerk test for Kim lesions

A

FF to 90; internal rotation to shoulder; then axial load in posterior direction - a clunk will be felt as arm moves into extension and reduces

65
Q

stages of calcific tendonitis

A

pre-calcific (metaplasia of tenocytes into chondrocytes); calcific stage with 3 subtypes (formative, resting, resorptive)

66
Q

two types of calcific tendonitis

A

Type 1 is fluffy on XR and is acute, painful, usually during formative phase; type 2 is more subacute/chronic with discrete mineralization

67
Q

pec vs subscap and insertion on LT

A

pec inserts LATERAL to biceps tendon

68
Q

best MRI for pasta tears

A

MR arthrogram in ABER position - takes tension off cuff so contrast can fill the space

69
Q

what position is arm after post shoulder dislocation

A

fixed in IR - wont externally rotate due to engagement of ant humeral head on posterior glenoid

70
Q

thoracic outlet syndrome affects what

A

subclavian aa/vein and LOWER trunk (C8-T1) - ulnar nerve (ring, little finger and intrinsics)

71
Q

injury to posterior branch of axillary nerve affects

A

lateral shoulder sensation and terres minor weakness

72
Q

percentage of pts over 60 with RCT AND OA

A

less than 10%

Ravi Board/OITE Prep (9 decks)

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